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Hypertension

Hypertension (HTN or HT), also known as high
blood pressure (HBP), is a long termmedical
condition in which the blood pressure in
the arteries is
persistently elevated. High blood pressure usually does not cause
symptoms. Long term high blood pressure, however, is a major risk factor
for coronary artery disease, stroke, heart failure, peripheral vascular disease, vision loss,
and chronic kidney disease.

High blood pressure is classified as
either primary (essential) high blood pressure or secondary high blood pressure. About
90–95% of cases are primary, defined as high blood pressure due to nonspecific
lifestyle and genetic factors. Lifestyle factors that increase the risk
include excess salt, excess body weight, smoking,
and alcohol. The remaining 5–10% of cases are categorized as secondary
high blood pressure, defined as high blood pressure due to an identifiable
cause, such as chronic kidney disease, narrowing of the kidney arteries, an endocrine disorder, or the use of birth control pills.

Blood pressure is expressed by two
measurements, the systolic and diastolic pressures,
which are the maximum and minimum pressures, respectively. Normal blood
pressure at rest is within the range of 100–140 millimeters mercury (mmHg) systolic and
60–90 mmHg diastolic. High blood pressure is present if the resting blood
pressure is persistently at or above 140/90 mmHg for most adults. Different
numbers apply to children. Ambulatory blood pressure monitoring over
a 24-hour period appears more accurate than office best blood pressure measurement.

Lifestyle changes and medications can
lower blood pressure and decrease the risk of health complications. Lifestyle
changes include weight loss, decreased salt intake, physical exercise, and a
healthy diet. If lifestyle changes are not sufficient then blood pressure medications are used. Up
to three medications can control blood pressure in 90% of people. The treatment
of moderately high arterial blood pressure (defined as >160/100 mmHg) with
medications is associated with an improved life expectancy. The
effect of treatment of blood pressure between 140/90 mmHg and
160/100 mmHg is less clear, with some reviews finding benefit and others
finding a lack of evidence for benefit. High blood pressure affects
between 16 and 37% of the population globally. In 2010 hypertension was
believed to have been a factor in 18% (9.4 million) deaths

Signs and symptoms

Hypertension
is rarely accompanied by symptoms, and its identification is usually throughscreening,
or when seeking healthcare for an unrelated problem. Some with high blood
pressure reportheadaches(particularly
at theback of the headand in the morning), as well aslightheadedness,vertigo,tinnitus(buzzing
or hissing in the ears), altered vision orfainting episodes.These symptoms, however, might be
related to associatedanxietyrather
than the high blood pressure itself.

Onphysical examination,
hypertension may be associated with the presence of changes in theoptic fundusseen
byophthalmoscopy.The severity of the changes typical ofhypertensive
retinopathyis graded
from I–IV; grades I and II may be difficult to differentiate.The severity of the retinopathy
correlates roughly with the duration and/or the severity of the hypertension.

Secondary hypertension

Hypertension
with certain specific additional signs and symptoms may suggest secondary
hypertension, i.e. hypertension due to an identifiable cause. For example,Cushing's syndromefrequently causes truncal obesity,glucose intolerance,moon face, a hump of fat behind the
neck/shoulder, and purple abdominalstretch marks.Hyperthyroidismfrequently causes weight loss
with increased appetite,fast heart rate,bulging eyes, and tremor.Renal artery stenosis(RAS) may be associated with a
localized abdominalbruitto the left or right of the midline
(unilateral RAS), or in both locations (bilateral RAS).Coarctation of the
aortafrequently
causes a decreased blood pressure in the lower extremities relative to the
arms, and/or delayed or absentfemoral arterial pulses.Pheochromocytomamay cause abrupt
("paroxysmal") episodes of hypertension accompanied by headache,palpitations,pale appearance, andexcessive sweating.

Hypertensive crisis

Severely
elevated blood pressure (equal to or greater than a systolic 180 or diastolic
of 110) is referred to as a hypertensive crisis. Hypertensive crisis is
categorized as eitherhypertensive urgencyorhypertensive
emergency, according to the absence or presence of end organ damage,
respectively.

Inhypertensive urgency,
there is no evidence of end organ damage resulting from the elevated blood
pressure. In these cases, oral medications are used to lower the BP gradually
over 24 to 48 hours.

Inhypertensive
emergency, there is evidence of direct damage to one or more organs.The most affected organs include the brain,
kidney, heart and lungs, producing symptoms which may include confusion,
drowsiness, chest pain and breathlessness.In
hypertensive emergency, the blood pressure must be reduced more rapidly to stop
ongoing organ damage,however,
there is a lack of randomised controlled trial evidence for this approach.